Pharmacy Practice > Exam 1 > Flashcards
Exam 1 Flashcards
Pharmacy law, SIGS, drug information, and medical terminology
AA
Affected area
AC
Before meals
(turn on the AC before you eat)
AS and AD
left ear (AS)
right ear (AD)
ATC
Around the clock
AU
Both ears
BM
Bowel movement
C.
With
Daily or QD (not really supposed to us QD)
Once daily
DAW
dispense as written
dc
discontinue
dil.
dilute
EN
Each nostril
gtt.
drops
HS
before sleep
ID
intradermal
inf.
infusion
IN
Intranasal
IT
intrathecal
MR
may repeat
NPO
nothing by mouth
NR
no refills
NTE
not to exceed
OS and OD
left eye
right eye
OU
both eyes
PC
after meals
(do not play the PC till after meals)
PR
per rectum (rectally)
PV
per vagina (vaginally)
Q
Every
QAM
Every morning
QID
four time a day
(QID like quad or 4)
QH
every hour
Q(#)H
Every # of hours
QHS
every night at bedtime
QNT
every night
QPM
every evening
QOD
every other day
QS
quantity sufficient
s.
without
SL
sublingual
ss
one-half
TID
three times a day
(tri is 3)
ung.
ointment
UD
as directed
WA
while awake
WC
with meals
stomato
mouth
encephalo
brain
myelo
spinal cord/ bone marrow
entero
intestine
procto
anus
orchido
testis
oophoro
ovaries
salpingo
uterine tubes
cysto
bladder
hemo
blood
cata-
down
(catatonic state, you are down)
contra
against
(against contraband)
demi
half
(demigod, half human half god)
dia
complete
(diameter measures complete inner circle)
dys-
pain
-ia
condition of
-algia
painful condition
(fibromyalgia is pain in muscles)
-atric
treatment
(bariatric surgery fixes biggness)
-centesis
to puncture
(cardiocentesis is a surgery that involves puncturing the heart)
-dynia
pain
-ecstasis
dilation
bronchiectasis where the lungs have become too wide
-emia
blood condition
leukemia
-graphy
process of recording
-iasis
abnormal condition
(psoriasis is abnormal immune system that causes skin cells to multiply too rapidly)
-oma
tumor
lymphoma
-ity
condition, state
(ability is like state of being able)
-opia
sight
-megaly
enlargement
(mega is large)
-opsy
to view
necropsy is another term for an autopsy
-otomy
incision
lobotomy
-oxia
oxygen condition
hypoxia is low oxygen
-penia
deficiency
cytopenia
-pathy
pertaining to disease
neuropathy is a nerve disease
-pheresis
removal
(hemapheresis is the removal of blood)
-plasty
formation or repair
-pnea
breath
-ptosis
drooping
-uria
urine
-tomy
surgical incision
-rrhagia
excessive flow
hemorrhage is excess bleeding
The Ohio Board of Pharmacy consists of _________ members appointed by the governor for 4 years. _____ of those members are licensed pharmacists and ______ is a member of the public.
9
8
1
T or F: The current executive director for the Ohio Board of Pharmacy is a pharmacist and has to be a pharmacist.
False.
Executive director does not have to be a pharmacist and is currently not a pharmacist.
The Board of Pharmacy serves what?
The public
The Ohio Board of Pharmacy obviously licenses pharmacists and pharmacy interns. What are the other 3 things they license?
- Terminal and wholesale distributors of dangerous drug
- Home medical equipment service providers
- Medical Marijuana dispensaries
(pharmacy technicians are registered but not licensed)
What are the 4 requirements to become a pharmacy intern for Ohio?
- Enrollment in a college of pharmacy
- Completed 60 semester or 90 quarter hours of college
- Has begun taking professional classes related to pharmacy
- Submit a request for a criminal background checl`
Pharmacy interns can performs several tasks under the ____________ of the pharmacist. The ____________ pharmacist determines if the intern is competent to perform those funtions.
Direct supervision
Supervising
What are the 9 tasks that pharmacy interns can perform under the direct supervision of a pharmacist?
- Sell schedule V controlled substances without a prescription (much more common in the past but not common now. would include things that cough syrup with codeine)
- Recieve oral (phoned in) prescription even for controlled substances
- Transfer prescription copies from your pharmacy to another (except for controlled substances
- Counsel patients
- Administer immunization (with additional requirements)
- Dispense naloxone per protocol (give give prescription narcan without prescription and then bill insurance)
- Perform sterile and nonsterile compounding
- Perform diagnostic testing
- Stick automated drug storage devices
What are the requirements for a pharmacy to give immunizations?
- Flu and Covid without prescription for those 7 and older (will be changed to 5 in October 2024)
- Give CDC (anything other than flu and covid) recommended immunizations to those 7-13 years with a prescription
- Give CDC (anything other than flu or covid) recommended immunizations to those 13 and older without a prescription
May a district pharmacy manager legally require all pharmacy interns employed by the chain to receive phoned prescriptions?
No, only the supervising pharmacist at that location has the ability to say that. It is within the capabilities of the pharmacy intern to be able to take phoned in prescriptions.
May a supervising pharmacist leave a pharmacy intern who is in her final year of pharmacy school alone in the pharmacy to counsel a patient while they go get lunch?
No, the pharmacy intern must do tasks that are directly supervision of the pharmacist. However, they are able to counsel patients if they are under supervision.
What are the 6 requirements to be licensed as a pharmacist?
- 18 years or older
- Good moral character and habits
- Graduate from a recognized pharmacy program
- Pass both MPJE and NAPLEX
- Complete minimum requirements for pharmacy internship
- Submit request for criminal background check
When must pharmacist and pharmacy intern license be renewed?
Renewed every odd numbered year on September 15th
In order to renew the license, what must pharmacist provide?
Proof of continuing education
Pharmacist and pharmacy interns must notify the broad within ___________ days if there is a residential change, email change, change in employment, and name change.
30
If a pharmacy intern has left school, they must notify the board within ___________.
72 hours
What is categorized as a dangerous drug?
- Prescription drugs that are RX only
- Injectable drugs including insulin that you can get over the counter
- Exempt narcotics (codeine cough syrup)
What is a controlled substance?
A drug or substance that has the potential for abuse and misuse. It is also referred to as a controlled drug or scheduled drug that is controlled by the DEA.
There are 5 schedules of controlled substances, what are they the schedules and what do they mean?
Schedule I- High potential for abuse and no accepted medical use
Schedule II- High potential for abuse but has accepted medical use
Schedule III- Potential for abuse but less so than schedule II
Schedule IV- Potential for abuse but less than schedule III
Schedule V- Potential for abuse but less than schedule IV. These are the exempt narcotics
All pharmacies that stock and dispense controlled substances must be registered with the ___________. All practitioners that prescribe controlled substances must be registered with the ____________ and their _____________ _____________ MUST be on all prescriptions of controlled substances.
DEA
DEA
DEA number
All pharmacies must be registered with the Ohio Board of Pharmacy and are give a ____________ license. If they stock and dispense controlled substances, they must register with the _______.
TDDD (Terminal Distributor of Dangerous Drugs)
DEA
The pharmacist that is in charge at all times is called the _________________.
Responsible person (pharmacy director in an instituation)
When a prescription is intended for a patient in an inpatient setting, it is called a ________________.
Medication order
The prescribing of of drugs from providers must be limited to their __________________________.
Scope of practice
What are the 3 main responsibilities of the responsible person/ pharmacy director?
- Be responsbile for the practice of pharmacy
- Provide supervision and control of the dangerous drugs
- Maintain all drug records required by state and federal law
Who are the different providers that can prescribe drugs?
Physicians, Dentist (DMD, DDS), Optometrists (OD), Podiatrists (DPM), Veterinarians (DVM), Nurse Practitioners and Physicians Assistants
A prescription is a written, electronic, or oral order for drug or combinations of mixtures of drugs to be used be a _____________________________ or for the treatment of a ____________________________ issued by a licensed healthcare professional authorized to prescribe drugs.
Particular Individual
Particular ailment
What are the 4 things required to be written on a prescription in Ohio?
- Date when issued (when prescriber wrote it)
- Prescriber information
- Patient information (full name and address)
- Drug information
For prescriber information that must be written on a prescription, what are the specific things that need to be included?
- Full name for provider (Daniel Smith, MD) or D. Smith MD
- Credentials (MD, DO, DVM, etc)
- Address of clinic
- Phone number to reach provider during business hours
- DEA # if it is a controlled substance prescription
- Manual signature
For the drug information must be written on a prescription, what are the specific things that need to be included?
- Name of drug
- Strength of drug
- Quantity to be dispensed (if a controlled substances it must be written numerically and alphabetically like 10 and ten)
- Directions for use
- Diagnosis code for a controlled substance
- Intended day supply for controlled substance and gabapentin
- # of refills
What is the prescriber does not include refill information on the prescription?
Assume there are zero refills for that medication
How many non-controlled drugs can be included on a prescription?
No more than 3 drugs
What if the prescriber puts “refill as needed” or “refill PRN”?
If not a controlled drug, it can be refilled for up to a year but this is illegal to do for controlled substances.
How many controlled drugs can be included on a prescription?
Only 1
Prescriptions can be faxed to a pharmacy. However the original prescription must be authorized and ___________ by the prescriber and then transmitted to the pharmacy by the prescriber or the prescriber’s agent via fax.
signed
What if a prescriber writes for Xanax (Schedule IV) and penicillin on the same prescription?
The Xanax cannot be filled but you could fill the penicillin. In this situation, you should call the provider and ask them to send over two separate prescriptions for the drugs.
What are the 2 requirements for a faxed prescription?
- Original written prescription must remain in the patient’s chart
- Fax must include the fax # number and header of the clinic
Can a patient fax over his prescription so they will be ready when they go to the pharmacy?
Absolutely not. The prescriber or prescriber’s agent can only fax over prescriptions.
Oral prescriptions in Ohio include called-in or verbal prescriptions. A prescription for an original or refilled medications can be transmitted orally by the prescriber or the prescriber’s agent under what conditions?
The call must be immediately be put into writing including:
1. Name of prescriber
2. Name of prescriber’s agent calling it in
3. Signature or initials of the pharmacist receiving it
Can a pharmacy intern or technicians receive an oral prescription?
Yes. However, they must also initial or sign the newly written down prescription and the pharmacist must sign off on it.
What drug class cannot be received as an oral prescription?
Schedule II drugs
Can pharmacy technicians receive oral refill authorizations?
Yes, but only certified technicians can.
What is an electronic prescription (E-script)?
This is a prescription sent directly from a prescriber to the pharmacy via a computer system.
Can pharmacy interns transfer controlled drug prescriptions?
No, only pharmacist can transfer controlled drug prescriptions.
May pharmacy interns receive oral prescription for controlled substances?
Yes, pharmacy interns can (not CII) but certified technicians cannot.
_______________ prescriptions must be e-scribed.
Schedule II
From the date written/prescribed, non-controlled substances are good to be filled by the patient within _________.
1 year
From the date written/prescribed, Schedule V drugs are good to be filled by the patient within _______________.
1 year
From the date written/ prescribed, Schedule II, III, and IV drugs are good to be filled by the patient within ___________.
6 months
A prescription that is written for the first-time ever, must be filled by the patient within _______________.
6 months
How many refills may a prescription have for both Schedule III and IV drugs?
Up to 5 refills in 6 months from the date of issuance
How many refills may a prescription have for both noncontrolled and schedule V drugs?
As many refills as desired for up to 1 year
How many refills may a prescription have for Schedule II drugs?
NONE
Any opioid containing drug (not just schedule II) prescribed for outpatients must be filled by the patient/ dispensed within__________________.
14 days
What is required on a prescription label in an inpatient/institutional setting?
- Brand or generic name of drug
- Route of administration
- Drug strength or volume
- Control/ lot #
- Expiration date
- Identification of the manufacturer, packager, or distributor
- If for a parenteral admixture it will need the patient name, name and amount of solution, name and amount of drugs added, expiration date, and name and address of institution
What are the 2 opioid containing drugs that are exceptions to the 14 day fill rule?
Buprenorphine for opioid use disorder and opioid-containing anti-diarrheals
Do opioid containing drug have be refilled and picked up by the patient within 14 days?
No
What is required on a prescription label in an outpatient/community setting?
- Date of dispensing/filled
- Serial # of prescription
- Pharmacy name, address and phone #
- Patient full name
- Prescriber full name
- Drug name (if generic need to put name of distributor)
- Drug strength
- Directions for use
- Quantity dispensed
For parenteral admixtures (2 or more compounds mixed together) in a hospital setting, what are the labeling requirements?
- Patient’s name
- Name and amount of solution
- Names and amounts of the drugs added
- Expiration date
- Name and address of institution
Can patients transfer a prescription from one pharmacy to another?
Yes under certain conditions
How many times can controlled drugs be transferred from one pharmacy to another?
1 time only. The only exception is for pharmacies that share a real time online database which allows for transfer for as many times as there are refills. (Still would not include Schedule II as you cannot have refills for these)
How many times can non-controlled prescriptions be transferred from one pharmacy to another?
As many times as there are refills (ie: 5 refills = 5 transfers)`
_________ and __________ can transfer prescriptions to another pharmacy as long as they are not controlled substances.
Pharmacy interns
Certified technicians
Only pharmacist can transfer ____________ to another pharmacy.
Controlled substances. This must be directly communicated between two pharamcists.
In addition to everything that already must be included on a prescription, what else must be included on the prescription when it is transferred from one pharmacy to another?
For pharmacy receiving the transfer:
- “TRANSFER” must be on the face of the prescription
- Full name of pharmacist receiving transfer (if tech or intern, they must include full name and supervising pharmacist)
- Date of transfer
- Prescription # assigned by the other pharmacy
- Name and address of pharmacy transferring the prescription (their DEA # if it is a controlled substance)
- Date of issuance of original prescription
- Date of first time dispensed
- Original number of refills issued
- Date of last refill
- Number of valid refills remaining
- Full name of pharmacist providing the prescription transfer information (if intern or tech, must include their full name and supervising pharmacist)
What must the pharmacy that has transferred the new prescription to another pharmacy do?
- Invalidate the prescription in the computer record
- Add the date of transfer to the computer record
- Full name of the pharmacist who provided the transfer to the other pharmacy in the computer record
- Name and address of pharmacy requesting the transfer (DEA # is controlled substance)
- Full name of the pharmacist receiving the prescription transfer
If intern or tech has done it, must include their name and the supervising pharmacist name
Are pharmcists required to provide counselling to patients?
They are required to offer to provide counselling for new or refilled drugs.
How can counselling be done?
Face to face
Over the phone
In-writing
Who can counsel patients?
Pharmacist and interns
Let’s say the hospital pharmacy is closed and there are no pharmacists present and a patient really needs a medication. How can this medication be obtained?
A licensed healthcare professional designated by the pharmacy director can administer a drug from the emergency box/ contingency supply.
Can the emergency box/ contingency supply be used if the pharmacy is busy?
No! It can only be used in an emergency and no pharmacist is present and the pharmacy is closed.
What if the drug that is needed is not stored in the emergency box/ contingency supply?
2 employees can enter the pharmacy to locate the drug that is an immediate need for the patient. 1 person must be a certified by the Board of Nursing or the Board of medicine and the other person can be whomever that works at the hosptial.
Can a hospital receptionist and critical care nurse enter the pharmacy together when a pharmacist is not present to obtain a drug for a patient?
Yes. Assuming this is an emergency and it is not in the emergency box/ contingency supply, they can enter.
T or F: It is optional to keep records of who accessed the pharmacy, the data and time, the drug obtained, the patient’s name , and the ordering prescriber after 2 employees went into the pharmacy to get an emergency medication for a patient when a pharmacist was not present.
False. It is not optional, it is required. All the things listed are required to be recorded and documented.
A pharmacist can exchange the brand name drug for the generic unless…
- The prescriber writes dispense as written
- Indicates that this brand is particularly medically necessary
- The patient refuses the generic
- The generic costs more than the brand
A prescriber writes a prescription for Percocet and the patient would like the generic (oxycodone/acetaminophen) instead. Can you dispense the generic?
In Ohio it is optional, but yes you can do it. In Kentucky, it is mandatory to dispense the generic.
If a generic is dispensed in place of the brand name drug, the pharmacist must indicate that _________________ was made.
a generic substitution was made (ie: Lisinopril substituted for Zestril or “Generic Substitution made”)
A patient is completely out of medication, does not have any refills, and their prescriber’s office is closed, and he really needs it. Is there anything the pharmacist can legally do to help the patient?
A pharmacist may dispense 72 hr supply or 30 day supply of a dangerous drug without a valid prescription if the pharmacy has record of the prescription, the pharmacist cannot contact their providers, and the drug is essential to maintain life and failure to dispense would result in death or harm.
Can a pharmacy give an emergency refill of 72hrs or 30 days to a patient that has never been to their pharmacy before and that pharmacy has no record of their drug?
No. The pharmacy would need to have a record showing that the refills are gone or expired in order to give them an emergency supply.
If all other criteria are met to give a refill, the pharmacist must use their professional opinion and only given an emergency refill is the drug is ___________________ or failure to dispense the drug would result in ______________________.
Essential to maintain life
Death or harm
Can any pharmacy or pharmacist give an emergency refill for schedule II drugs?
Absolutely not
If a pharmacist make an emergency refill, they must notify the prescriber within ____________, obtain authorization for additional __________, and keep a record of the dispensing of the emergency refills.
72 hours
refills
If a drug is not a ________________ and the patient has been ________________ with therapy demonstrated through the pharmacy records, the pharmacist can give a ________ emergency supply.
Controlled substance
Consistent
30 day
If a drug is a ______________ (not schedule II though as no emergency refills for that) and/or the patient is not consistent with the medication, the pharmacist can only give a ____________ emergency supply
Controlled substance
72 hour
A patient can only receive an emergency supply __________ for each controlled substance prescription on file.
Once!
A patient can receive a ___________ refill for their 1st emergency refill and a _______________ supply for their 2nd and 3rd emergency refill for non-controlled substances.
30 day
Up to 7 day refill
What are the criteria that pharmacists, pharmacy interns, and certified technicians complete in order to administer immunizations?
- Complete course for administration of immunizations approved by the Board of Pharmacy
- BLS certified every 2 years
- Practice according to protocol established by a physician approved by the Board of Pharmacy
All physician-established protocols for immunizations must be signed and dated by a physician ____________ to implementation of giving vaccines.
PRIOR
The protocol to give immunizations must be renewed every _______ years.
2
Who in the pharmacy can administer EPI or diphenhydramine to individuals in emergency situation resulting from an adverse reaction to a vaccine given?
Only the pharmacist
Once a person in the pharmacy is given the vaccine, the ________ and the ___________ need to be notified within _______ days. This does not apply to the flu shot.
Patient’s physician
Board of Health
30
What is OARRS?
This is the Ohio Automated Rx Reporting System
What is the purpose of OARRS?
The purpose is that it is a tool to assist healthcare professionals in providing better treatment for patients with medical needs while quickly identifying drug seeking behaviors.
What are the 4 things that must be reported to OARRS?
- All controlled substances (CII-CV)
- Gabapentin
- Naltrexone
- Medical marijuana
Who must report their data to OARRS?
- All pharmacies within Ohio
- All pharmacies that ship prescriptions to Ohio residents
- All prescribers, except veterinarians
Pharmacies must submit data to OARRS at least ___________.
1 time per day
Who can obtain an OARRs report?
- Licensing entities that govern prescribers and those who administer or dispense drugs
- Law enforcement officers only with a subpoena
- A prescriber that is related to the patient (has been seen or made an appointment)
- A pharmacist that is related to the patient (received their prescription)
T or F: A pharmacist can share their login information to OARRs with their pharmacist’s delegate who can also obtain OARRs reports.
False. A pharmacist should never give out their OARRs login information. The pharmacist delegate needs to be registered and get their own login.
Is it easy or hard for a patient to get ahold of their own OARRs report?
It is very difficult as they need to go to the Board of Pharmacy in Columbus, Ohio and pay for it.
What are the 6 reasons that require a pharmacist to run an OARRs report?
- Pt adds new or different controlled substance to therapy
- OARRs report has not been reviewed for that pt in the last 12 months
- Prescriber is located outside the usual pharmacy geographical area
- Pt is outside the usual pharmacy geographical area
- Pharmacist believes a pt has received controlled substances prescriptions from more than 1 prescriber in the last 3 months (does not count if the prescribers practice at the same group)
- Pt is exhibiting signs of potential abuse or diversion
Pharmacist ___________ provide copies of OARRs report to anyone. They can discuss with the ______________ that has a relationship with the patient thought.
CANNOT
Prescriber
OARRs data is not ______________.
Evidence
While reviewing a patient chart, a provider notes the patient experienced epistaxis. What did the patient experience?
A. Chest pain
B. Blood in urine
C. Sinus infection
D. Nosebleed
D. Nosebleed
